3.3 In addition, in order for a
freestanding inpatient/residential SUDRF to be authorized, the SUDRF
shall comply with the following requirements:
3.3.1 An SUDRF shall be currently
accredited by TJC, CARF, CoA, or an accrediting organization approved
by the DHA. The contractor may submit additional accrediting organizations
for TRICARE authorization, subject to approval by the GDA.
3.3.2 The SUDRF shall be licensed
as an SUDRF to provide SUD services within the applicable jurisdiction
in which it operates.
3.3.4 The SUDRF shall comply with
all requirements applicable to institutional providers generally concerning
accreditation requirements, preauthorization, concurrent care review,
claims processing, beneficiary liability, double coverage, utilization
and quality review, and other matters.
3.3.5 The SUDRF shall not be considered
an authorized provider, nor may any benefits be paid to, the facility for
any services provided prior to the date the facility is approved
by the DHA, or designee.
3.3.6 All services,
supplies, equipment and space necessary to fulfill the requirements
of each patient’s individualized diagnosis and treatment plan are
included in the reimbursement approved for an authorized SUDRFs.
All mental health services must be provided by the TRICARE authorized
individual professional provider of mental health services. Assessments
will include documentation of the outcomes of standardized assessment measures
for Post-Traumatic Stress Disorder (PTSD), anxiety disorders, and
depressive disorders using the PTSD Checklist (PCL-5), Generalized
Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9
or A), respectively, at baseline, at 60 calendar day intervals,
and at discharge (see
Chapter 1, Section 5.1 for details). [Exception:
Residential treatment programs that employ individuals with master’s
or doctoral level degrees in a mental health discipline who do not
meet the licensure, certification, and experience requirements for
a qualified mental health provider, but are actively working toward
licensure or certification, may provide services within the all-inclusive
per diem rate, but such individuals must work under the clinical
supervision of a fully qualified mental health provider employed
by the facility.]
3.3.7 Case management
services required. The facility must provide case management services
that help assure the patient’s appropriate living arrangements after
treatment hours, transportation to and from the facility, arrangement
of community based support services, referral of suspected child
abuse to the appropriate state agencies, and effective care arrangements,
at a minimum.
3.3.8 The SUDRF
shall enter into a written participation agreement with the DHA,
or designee. (See
Section 12.3 and
Addendum D.)
3.3.9 The SUDRF agrees to notify
the referring provider or Market/Military Medical Treatment Facility
(MTF) referral management office (on behalf of the military provider)
when a Service member or beneficiary, in the provider’s clinical
judgment, meets any of the following criteria:
• Harm to self - The provider
believes there is a serious risk of self-harm by the Service member
either as a result of the condition itself or medical treatment
of the condition;
• Harm to others - There is a
serious risk of harm to others either as a result of the condition
itself or medical treatment of the condition. This includes any
disclosures concerning child abuse or domestic violence;
• Harm to mission - There is
a serious risk of harm to a specific military operational mission.
Such a serious risk may include disorders that significantly impact
impulsivity, insight, reliability, and judgment;
• Inpatient care - Admitted or
discharged from any inpatient mental health or substance use treatment
facility as these are considered critical points in treatment and
support nationally recognized patient safety standards;
• Acute medical conditions interfering
with duty - Experiencing an acute mental health condition or is
engaged in an acute medical treatment regimen that impairs the beneficiary’s
ability to perform assigned duties;
• Substance abuse treatment program
- Entered into, or is being discharged from, a formal outpatient
or inpatient treatment program.